LuAnn Eaton
Brooktondale,NY
Summary
Results-driven Claims Examiner with extensive experience at New York State Insurance Fund, excelling in claims handling and negotiation. Proven ability to analyze medical reports and manage complex case files, ensuring compliance and timely resolutions. Strong communication skills enhance customer relationships and streamline claims processing for optimal outcomes.
Overview
37
37
years of professional experience
Work History
Claims Examiner
New York State Insurance Fund
Binghamton, NY
01.2005 - 12.2023
- Analyzed and processed claims through well-developed action plans to appropriate and timely resolution.
- Conducted full investigations to evaluate compensability and liability.
- Handled complex claims caseload, ensuring high-quality service from inception to closure.
- Negotiated settlements of claims within designated authority.
- Analyzed medical reports and evidence for compliance of the New York workers compensation policies and regulations.
- Maintained detailed and accurate claim files to support effective claims management.
- Utilized strong interpersonal and communication skills to foster relationships with clients and stakeholders.
- Prioritized workload efficiency while simultaneously ensuring streamlined claims processing and accuracy.
Quality Assurance Reviewer
Office of Temporary Disability & Assistance
Binghamton, NY
12.1998 - 01.2005
- Evaluated applications for disability benefits to ensure adherence to policy guidelines, enhancing accuracy of determinations.
- Reviewed case files to identify errors or discrepancies, recommending corrective actions to improve overall quality of assessments.
- Reviewed applications for temporary disability benefits to ensure compliance with regulations.
- Analyzed case files for accuracy and completeness in documentation submissions.
- Collaborated with staff to clarify applicant information during the review process.
Administrative Assistant
Office of Mental Retardation & Developmental Disabilities
Ithaca, NY
05.1987 - 12.1998
- Managed office correspondence and documentation to support client services.
- Answered phone calls and emails to provide timely information for effective business communication.
- Entered data into spreadsheets to maintain accurate records using Microsoft Excel.
Education
High School - Business
Candor High School
Candor, New York06.1986
Skills
- Claims handling
- Claims investigation
- Settlements negotiation
- Medical report evaluation
- Risk assessment
- Case file management
- Workload prioritization
- Client relationship management
- Effective communication
Accomplishments
Certificates of Recognition from DCI for fraud detection
Certificate of Recognition for 100% Timely Initial Payments
Certificates of Recognition for Section 32 Settlements
Certificate of Recognition for 100% Timely Initial Payments
Certificates of Recognition for Section 32 Settlements
Timeline
Claims Examiner
New York State Insurance Fund
01.2005 - 12.2023
Quality Assurance Reviewer
Office of Temporary Disability & Assistance
12.1998 - 01.2005
Administrative Assistant
Office of Mental Retardation & Developmental Disabilities
05.1987 - 12.1998
High School - Business
Candor High School